Kids in Crisis reached out to Wisconsin communities in 2017 to continue the discussion about youth mental health and teen suicide.

Buy Photo

Jennifer King comforts Bryn Yates during a Sources of Strength training session at the Boys and Girls Club of the Fox Valley. The program encourages students to dream up and implement their own ideas for preventing suicide in their schools.(Photo: Josh Clark/USA TODAY NETWORK-Wisconsin)Buy Photo

Editor's note: The following story is part of the "Kids in Crisis" series by the USA TODAY NETWORK-Wisconsin, which examines youth mental health and suicide. If you, or people you know, are experiencing suicidal thoughts, please text "HOPELINE" to 741-741 or call 1-800-273-8255 for help.

MILWAUKEE - She was hoping they'd never pick her name to speak. But Casey Schreiber, 16, mounted the stage. Wringing her hands in her sweatshirt pocket, she told the crowd she'd been bullied relentlessly from fourth to eighth grade.

There were more than 100 adults packed into the Anodyne coffee shop for "The Moth" story slam. She worried about how they were judging her, but she kept the words flowing.

"They'd tell me to kill myself, that I'm not worth anything, that I'm just a waste of space," Schreiber said. "I'd hear that every single day."

When Schreiber walked into Anodyne that December night, her friend urged her to put her name in to speak because of her experience with the event's theme: Rejection.

Other people needed to hear her story, her friend said.

The years of bullying, from school hallways to comments on her Instagram photos, had contributed to Schreiber's diagnoses of social anxiety and post-traumatic stress disorder. Getting on stage went against everything her amped-up nervous system was telling her.

But when Schreiber finished, host Dasha Kelly asked everyone in the room who could relate to the experience to hold up a single finger. Hands rose from nearly every chair.

"When you say something like that, you feel like a big red sign in the room and you feel so singled out and it feels so scary," Schreiber said. "But when people acknowledged that they understood, that made me feel so much better, and calmer and confident about my story."

When Schreiber first tried to get help, she hit wall after wall. Adults seemed to think the bullying was just a normal part of growing up. Her school counselor was always busy.

For Schreiber, things got better when her doctor and parents helped her find a therapist outside of school, one who helped her learn to give herself compliments and regain self confidence. Her family paid partly with insurance, and partly out of pocket.

Schreiber knows she was fortunate to get help — and that others have not. That's why she shared her story.

Bullying has often been cited as a precursor to suicide. It can exacerbate mental health challenges, which often make their first appearances in teenage years.

Less than a month before Schreiber took the stage, Milwaukee County lost its eighth minor to suicide in 2017 — the highest annual total in the medical examiner's 14 years of data.

His name was Quentin Espinoza. People close to him said he'd been bullied for years.

Not another

Youth suicide rates have been rising nationwide since 2007. Wisconsin's numbers have been worse than the national average every year.

For the past two years, USA TODAY NETWORK-Wisconsin has been examining the root causes of this rise with our "Kids in Crisis" series.

Each suicide triggers the question: How did this happen?

Whispers spread. Fingers point. Sometimes another suicide follows. Pursuit of the question can be a debilitating spiral.

But through the fog of grief, there's another question. How do we stop this from happening again?

Communities that lose a young person often end up building the best programs to address mental health and prevent suicide.

Appleton North High School, home to about 1,800 students, has lost three students to suicide in the last four years. In the wake of all that pain, staff have tackledthe issue head on.

"We want students to come out and ask about it," said principal Dave Pynenberg. "There isn’t any sweeping under the rug. You have to break the silence and then you have to be ready and prepared to work with it. That's our goal."

In addition to bringing therapists on campus to help students during the school day, Appleton Area School District staff are focused on strengthening relationships between students and their peers and teachers.

Teachers at Appleton North personally called every student before this school year began to check in on them. Staff asked how students' summer breaks went, checked if they had any worries about the coming school year, and — most importantly — established or built on a positive relationship with the student.

Pynenberg said all students are asked to identify a trusted adult at school. Many students have come to those adults with serious challenges, including suicidal thoughts.

What if every school responded with such urgency before experiencing such loss?

We can fix this

We know what works. Yet youth suicide rates have been rising across the nation for a decade and the problem remains shrouded.

Journalists are taught that reporting on suicide might be risky. Vulnerable readers may become more likely to consider it. Media coverage might make suicide seem romantic — or like a way to get revenge, or to get someone to finally listen.

The Netflix show "13 Reasons Why" was criticized last year for making it seem like the main character, Hannah, could exact revenge through her suicide. What young people were missing, critics argued, was that Hannah did not get to see or feel any of that revenge. She was permanently gone.

There are real risks involved in giving suicide a stage. But research also shows that careful conversations and coverage can make vulnerable people more likely to seek help — as well as motivate community action. Students at risk for suicide are already thinking about it, whether they have told anyone or not.

Last May, Pynenberg attended a funeral for the third student he lost to suicide at Appleton North.

In the first line of the obituary for Kodye Fassbender, 16, his family shared the fact that the death was a suicide. They said he would be remembered for his love of the outdoors, his willingness to help peers and his passion for organizations that help veterans who are injured or at risk for suicide.

The obituary continued:

"We hope Kodye's death can be a catalyst for more open conversations around mental health and suicide awareness."

Buy Photo

High school students brainstorm during a Sources of Strength training session at the Boys and Girls Club of the Fox Valley Thursday, Nov. 9, 2017, in Appleton, Wis. Josh Clark/USA TODAY NETWORK-Wisconsin(Photo: Josh Clark/USA TODAY NETWORK-Wisconsin)

Experts have identified several "protective factors" that can reduce the risk of suicide and more generally build good mental health for all students. According to the Suicide Prevention Resource Center, they are:

Effective behavioral health care: making therapy and psychiatric support affordable and accessible

Connectedness: fostering a sense of belonging to peers, family or community

Life skills: learning to manage stress, adapt and solve problems

Self-esteem: building a sense of purpose

Personal beliefs: nurturing the idea that things will get better

Evidence-based solutions that target each of these factors have not been thoroughly implemented across the state. Instead, our series has exposed a piecemeal approach.

1. Who has access to mental health care?

Some students get mental health support at school from counselors, psychologists, social workers or nurses. But Wisconsin staffing levels in these positions fall far below recommended levels. Many students say their counselors are always busy, or that counselors mainly want to focus on academics.

"(The school counselor) usually can't help me when I need it," said Jesse Pennington-Cross, a Glen Hills Middle School student who spoke at a state budget hearing in April. "There are kids waiting in the hall and her door is closed."

Jesse Pennington-Cross is embraced by her mom, Carla. Jesse is a student at Glen Hills Middle School who lives with mental health challenges and has advocated for more mental health services in schools.(Photo: Rick Wood/Milwaukee Journal Sentinel)

When families seek help for students outside of school, barriers abound.

Some mental health providers won't see patients who use public insurance because the government payment covers such a small portion of the cost of care. Even families with private insurance face long waiting lists, appointments that conflict with work or school, and high deductibles or other costs.

That's why programs that bring therapists on campus have been so successful. In Milwaukee Public Schools, most of the students who see the therapists brought in from Children's Hospital have never had any mental health services before.

MPS has found grant money so that parents are not charged, but the district has so far only stretched the program to 19 schools out of more than 150.

This summer, districts will be able to apply for funding from a new $3.25 million pool of state dollars for this purpose.

Linda Hall of the Wisconsin Association of Family and Children’s Agencies estimates that about 30 to 60 districts will be able to tap into the funds.

But there are more than 450 districts statewide.

2. Are students recruited to be part of the solution?

It's vital for youth to have trusted peers to help them feel supported and safe when reaching out for help. Pennington-Cross established one of her own goals for her school's official plan for meeting her mental health needs: to eat lunch with her friends.

At a training session for "Sources of Strength," a new suicide prevention program in Appleton schools, students brainstormed how they could be more welcoming to peers who eat lunch alone. The program empowers teens to create their own social media campaigns, events and artwork with the goal of making sure every student feels supported and able to find help.

Buy Photo

Appleton West High School junior Isaiah Donaldson listens to one of peers during the Sources of Strength training session at the Boys and Girls Club of the Fox Valley Thursday, Nov. 9, 2017, in Appleton, Wis. Josh Clark/USA TODAY NETWORK-Wisconsin(Photo: Josh Clark/USA TODAY NETWORK-Wisconsin)

"After depression and being alone, I wouldn't try to make an effort to meet new people, but I'd want someone to come," said Isaiah Donaldson, a junior at Appleton West High School and a leader with Sources of Strength.

"Now I can look around and see someone who's alone and I'll try talking to them and see where they're at. And if I'm the only person they have, they'll open up right away because that's what they've been waiting for. Everyone's kind of waiting to find someone they can open up to."

Our reporting has found a strong focus in recent years on training school staff to recognize mental health challenges and suicide warning signs. Far fewer schools have programs that tap into students to help.

Sources of Strength, taking hold throughout northeastern Wisconsin, is one such program. There's a similar projectcalled the Hope Squad, for which Prevent Suicide Greater Milwaukee is seeking funding. Teams of students meet regularly to plan anti-suicide and relationship-building campaigns.

3. Are mental health providers connecting with all students?

A family that communicates best in Spanish might need a Spanish-speaking professional. A student of color who is experiencing the stress of racism might benefit most from a therapist of color who can relate.

According to a 2017 state survey, black and Latino high school students were more likely to experience symptoms of depression and suicidal thoughts than white students.

Patricia McManus, who leads the Wisconsin Black Health Coalition, has worked to bring attention to the ways race-based trauma from slavery to ongoing racial discrimination impact health. Traumatic experiences have been shown to shape the brain, get passed through generations, and contribute to mental health challenges.

Kadihjia Kelly, a therapist based in the Fox Valley, has encouraged mental health providers to be able to identify racism as a cause for some mental health challenges and address it as such. Kelly has seen students so fatigued by battling racism that "they can no longer function."

Their work is helping to achieve a growing recognition of the toll of racism on mental health and the need for mental health professionals who can grapple with it.

Research has shown that people of color have better treatment outcomes when their clinicians share their race or ethnicity, or have training in cultural competency.

The most recent Children Come First Conference, an annual meeting of mental health advocates from around the state, had a workshop in November about how implicit bias — stereotypes and unconscious reactions to a person's race — can affect treatment of children. None of the 50 workshops in 2016 had focused on race.

4. Are LGBT+ students supported?

Students who identify as lesbian, gay or bisexual are significantly more likely to feel unsafe at school and attempt suicide, according to a CDC survey of high school students across the country.

In 2015, about 13 percent of LGB students said they had missed school because they feared for their safety, compared to 5 percent of heterosexual students. About 28 percent of LGB students said they'd been cyberbullied, compared to 14 percent of heterosexual students.

In the year before the survey, 60 percent of LGB students said they had experienced symptoms of depression, compared to 26 percent of heterosexual students. Thirty percent said they had attempted suicide, compared to 6 percent of heterosexual students.

Suicide attempts are also more common among transgender people and people who are gender nonconforming — meaning their gender or expressions don't entirely align with the gender they were assigned at birth.

According to a survey by an advocacy group, the National Center for Transgender Equality, more than half of transgender and gender nonconforming adults had attempted suicide if they had experienced discrimination, violence, refusal of health care or police harassment.

Children's Hospital of Wisconsin offers an emotional and mental health support group for transgender and gender nonconforming students.

The clinicians leading that group say it's important to be clear that mental health challenges and suicide attempts happen in these populations not because there's anything wrong with them, but because of how the rest of the world chooses to treat them — or not treat them.

"We have kids who are feeling unsupported by friends and family members and that leads to increased anxiety," said Jacquelyn Smith, a pediatric psychologist with Children's, who co-leads the group. "But when these kids are in situations where they feel supported, they do really well."

Schools and communities can greatly mitigate mental health challenges by supporting these students, using names and pronouns requested by the students, providing access to bathrooms and activities, and using lesson plans that draw on diverse points of view.

5. Are students being punished or arrested for mental health needs?

Some students dealing with depression, trauma and other conditions have triggers that make them feel unsafe or anxious and act out. Students classified with emotional behavior disabilities, which often stem from mental health conditions, make up 1% of Wisconsin public school students but receive 15% of suspensions and 7% of expulsions, according to our 2016 analysis of state data.

Madison School Board members are concerned about how behaviors that might be calmed and mitigated with staff training escalate into police being called and arrests being made. Government data show that, despite their small numbers, students with disabilities comprise a third of students referred to law enforcement by Wisconsin schools.

"If the behavior itself is rooted in mental health issues, and it often is, there's a slight chance that a student in court will end up with the support they need," Board Member T.J. Mertz said. "There's a better chance in our school-based system."

Mertz is part of a board committee that is involving community members in a thorough examination of the role of police in schools. Their recommendations, due in May, could call for a range of possible actions, from eliminating school-based police officers to ensuring officers in schools get mental health training alongside other staff.

At a summer meeting, the Milwaukee School Board asked for an external evaluation of how in-school police programs are working in Milwaukee Public Schools, with Board Member Terry Falk raising concerns that they could be exacerbating the "school to prison pipeline."

MPS staff have not announced the evaluator, but said research should begin shortly for a complete report by May. The budget for the study is $45,000.

We move forward by listening

It was April when Glen Hills student Jesse Pennington-Cross read her statement at a state budget hearing, expressing concern about the lack of counseling support at her school.

It was November when Glen Hills seventh grader Quentin Espinoza died by suicide.

It's time we hear their words with more urgency.

As we continue reporting this year, we will bring you the voices of teens. Some of them we've almost lost. But they're here, they're telling us what they need, and we need to hear them.

Look for warning signs

The following are warning signs that someone may be considering suicide, according to the American Foundation for Suicide Prevention. If you, or people you know, are experiencing suicidal thoughts, please text "HOPELINE" to 741-741 or call 1-800-273-8255 for help.